保留子宫在全盆底重建手术中的应用价值探讨

Analysis of the value of uterus reservation in pelvic reconstruction surgery

目的探究保留子宫在全盆底重建手术中的临床应用价值。方法采用回顾性研究,对患有Ⅲ～Ⅳ度盆底脏器脱垂并于2008年1月～2010年2月期间行手术治疗的患者362人作为研究对象。根据其手术方式将其分为两组:组1,保留子宫的全盆底重建手术(应用植入网片)共230人;组2,阴式切除子宫同时行全盆底重建手术(采用植入网片)共132人。比较两组患者术前一般情况,术前POP-Q分期,围手术期情况,术后18个月POP-Q分期及术后随访并发症产生情况。结果两组患者术前一般情况及POP-Q分期无明显差异,组1手术时间、术中出血量和住院时间均明显少于组2(P=0.000,0.000,0.001),术后18个月随访结果,组1中C点水平明显高于组2(P=0.020)。其它各点无明显差异。组1中出现补片暴露概率明显少于组2(P=0.001)。结论保留子宫的全盆底重建手术可使患者损伤更小、恢复更快、术后效果更好、并发症发生率降低,在生殖器官健康的前提下,保留子宫的全盆底重建手术可使患者获得更大的收益。

【Objective】 Evaluate the value of uterus reservation in pelvic reconstruction surgery.【Methods】 Choose 362 patients who take surgery in Shengjing hospital because of Ⅲ～Ⅳ degree pelvic organ prolapsed,and divide them into two groups.Group 1： uterus reserved in pelvic reconstruction surgery.Group2： hysterectomy in pelvic reconstruction surgery.The general condition,peri-operative outcomes and follow up data were compared between two groups.【Results】The general conditions and POP-Q stage do not seems difference.The operation time,blood loss volume and admission days in group 1 are less than group 2（P =0.000,0.000,0.001）.18 months after operation,some parameters are compared,the point C is higher in group 1 than in group 2（P =0.020）,and the mesh exposure probability in group 1 is less than group 2（P =0.001）.【Conclusion】In pelvic reconstruction surgery,reservation of uterus can minus the injury,decrease the possibility of reprolaps and the complications.In case of a health uterus,reservation of uterus will bring the patient more benefits.